Mohammadi Tima, Sadatsafavi Mohsen, Carlsten Chris
Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, Canada.
Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
ERJ Open Res. 2021 Mar 22;7(1). doi: 10.1183/23120541.00790-2020. eCollection 2021 Jan.
The demonstrable value of precision medicine, in the context of common environmental exposures, has scarcely been explored. This study evaluated the cost effectiveness of a preventive personalised intervention to reduce the adverse effect of air pollution in the context of asthma. A decision-analytic model was used to conduct a cost-utility analysis of prevention interventions in case of acute exposure to air pollution in mild asthma. Three different strategies, as follows, were compared: no preventive intervention; precision health strategy based on information from genotype testing, followed with treating high-risk patients; and prescribing additional medication to all mild asthmatics as a preventive intervention. The costs and quality-adjusted life years (QALYs) in the base case and alternative scenarios were obtained through probabilistic analysis. The results showed that the precision prevention intervention (anticipatory intervention for asthmatics, guided by relevant genetic abnormality, in the face of acute air pollution) is a cost-effective strategy compared with no such intervention, with an incremental cost-effectiveness ratio of CAD 49 555 per QALY. Furthermore, this strategy is a dominant strategy compared with an intervention that prescribes medication indiscriminately to all asthmatics. The incorporation of genomic testing to stratify risk of asthmatics to pollution-driven exacerbations, and then tailoring a preventive intervention accordingly, may be cost effective relative to untailored methods. These results lend plausibility to the use of precision medicine for limiting asthma exacerbation in the context of air pollution and, potentially, other exposures.
在常见环境暴露背景下，精准医学的可证明价值几乎未被探索。本研究评估了一种预防性个性化干预措施在哮喘背景下降低空气污染不良影响的成本效益。采用决策分析模型对轻度哮喘患者急性暴露于空气污染时的预防干预措施进行成本效用分析。比较了以下三种不同策略：不进行预防性干预；基于基因检测信息的精准健康策略，随后对高危患者进行治疗；以及给所有轻度哮喘患者开额外药物作为预防性干预措施。通过概率分析获得了基础病例和替代方案中的成本和质量调整生命年（QALY）。结果表明，与不进行此类干预相比，精准预防干预（面对急性空气污染时，由相关基因异常引导，对哮喘患者进行预期干预）是一种具有成本效益的策略，每QALY的增量成本效益比为49555加元。此外，与对所有哮喘患者不加区分地开药的干预措施相比，该策略是一种主导策略。将基因组检测纳入以分层哮喘患者因污染导致病情加重的风险，然后相应地制定预防性干预措施相对于未量身定制的方法可能具有成本效益。这些结果为在空气污染以及潜在的其他暴露背景下使用精准医学来限制哮喘病情加重提供了合理性依据。
